Rahul Rahul

Erim Yanik, Uwe Kruger, Xavier Intes et al.

To ensure satisfactory clinical outcomes, surgical skill assessment must be objective, time-efficient, and preferentially automated - none of which is currently achievable. Video-based assessment (VBA) is being deployed in intraoperative and simulation settings to evaluate technical skill execution. However, VBA remains manually- and time-intensive and prone to subjective interpretation and poor inter-rater reliability. Herein, we propose a deep learning (DL) model that can automatically and objectively provide a high-stakes summative assessment of surgical skill execution based on video feeds and low-stakes formative assessment to guide surgical skill acquisition. Formative assessment is generated using heatmaps of visual features that correlate with surgical performance. Hence, the DL model paves the way to the quantitative and reproducible evaluation of surgical tasks from videos with the potential for broad dissemination in surgical training, certification, and credentialing.

Anil Kamat, Rahul Rahul, Anirban Dutta et al.

Objective motor skill assessment plays a critical role in fields such as surgery, where proficiency is vital for certification and patient safety. Existing assessment methods, however, rely heavily on subjective human judgment, which introduces bias and limits reproducibility. While recent efforts have leveraged kinematic data and neural imaging to provide more objective evaluations, these approaches often overlook the dynamic neural mechanisms that differentiate expert and novice performance. This study proposes a novel method for motor skill assessment based on dynamic directed functional connectivity (dFC) as a neural biomarker. By using electroencephalography (EEG) to capture brain dynamics and employing an attention-based Long Short-Term Memory (LSTM) model for non-linear Granger causality analysis, we compute dFC among key brain regions involved in psychomotor tasks. Coupled with hierarchical task analysis (HTA), our approach enables subtask-level evaluation of motor skills, offering detailed insights into neural coordination that underpins expert proficiency. A convolutional neural network (CNN) is then used to classify skill levels, achieving greater accuracy and specificity than established performance metrics in laparoscopic surgery. This methodology provides a reliable, objective framework for assessing motor skills, contributing to the development of tailored training protocols and enhancing the certification process.

Aseem Subedi, Rahul, Lora Cavuoto et al.

The real-time assessment of complex motor skills presents a challenge in fields such as surgical training and rehabilitation. Recent advancements in neuroimaging, particularly functional near-infrared spectroscopy (fNIRS), have enabled objective assessment of such skills with high accuracy. However, these techniques are hindered by extensive preprocessing requirements to extract neural biomarkers. This study presents a novel end-to-end deep learning framework that processes raw fNIRS signals directly, eliminating the need for intermediate preprocessing steps. The model was evaluated on datasets from three distinct bimanual motor tasks--suturing, pattern cutting, and endotracheal intubation (ETI)--using performance metrics derived from both training and retention datasets. It achieved a mean classification accuracy of 93.9% (SD 4.4) and a generalization accuracy of 92.6% (SD 1.9) on unseen skill retention datasets, with a leave-one-subject-out cross-validation yielding an accuracy of 94.1% (SD 3.6). Contralateral prefrontal cortex activations exhibited task-specific discriminative power, while motor cortex activations consistently contributed to accurate classification. The model also demonstrated resilience to neurovascular coupling saturation caused by extended task sessions, maintaining robust performance across trials. Comparative analysis confirms that the end-to-end model performs on par with or surpasses baseline models optimized for fully processed fNIRS data, with statistically similar (p<0.05) or improved prediction accuracies. By eliminating the need for extensive signal preprocessing, this work provides a foundation for real-time, non-invasive assessment of bimanual motor skills in medical training environments, with potential applications in robotics, rehabilitation, and sports.

Jean-Paul Ainam, Rahul, Lora Cavuoto et al.

Airway management skills are critical in emergency medicine and are typically assessed through subjective evaluation, often failing to gauge competency in real-world scenarios. This paper proposes a machine learning-based approach for assessing airway skills, specifically endotracheal intubation (ETI), using human gaze data and video recordings. The proposed system leverages an attention mechanism guided by the human gaze to enhance the recognition of successful and unsuccessful ETI procedures. Visual masks were created from gaze points to guide the model in focusing on task-relevant areas, reducing irrelevant features. An autoencoder network extracts features from the videos, while an attention module generates attention from the visual masks, and a classifier outputs a classification score. This method, the first to use human gaze for ETI, demonstrates improved accuracy and efficiency over traditional methods. The integration of human gaze data not only enhances model performance but also offers a robust, objective assessment tool for clinical skills, particularly in high-stress environments such as military settings. The results show improvements in prediction accuracy, sensitivity, and trustworthiness, highlighting the potential for this approach to improve clinical training and patient outcomes in emergency medicine.

Anil Kamat, Rahul Rahul, Lora Cavuoto et al.

Motor skill acquisition in fields like surgery, robotics, and sports involves learning complex task sequences through extensive training. Traditional performance metrics, like execution time and error rates, offer limited insight as they fail to capture the neural mechanisms underlying skill learning and retention. This study introduces directed functional connectivity (dFC), derived from electroencephalography (EEG), as a novel brain-based biomarker for assessing motor skill learning and retention. For the first time, dFC is applied as a biomarker to map the stages of the Fitts and Posner motor learning model, offering new insights into the neural mechanisms underlying skill acquisition and retention. Unlike traditional measures, it captures both the strength and direction of neural information flow, providing a comprehensive understanding of neural adaptations across different learning stages. The analysis demonstrates that dFC can effectively identify and track the progression through various stages of the Fitts and Posner model. Furthermore, its stability over a six-week washout period highlights its utility in monitoring long-term retention. No significant changes in dFC were observed in a control group, confirming that the observed neural adaptations were specific to training and not due to external factors. By offering a granular view of the learning process at the group and individual levels, dFC facilitates the development of personalized, targeted training protocols aimed at enhancing outcomes in fields where precision and long-term retention are critical, such as surgical education. These findings underscore the value of dFC as a robust biomarker that complements traditional performance metrics, providing a deeper understanding of motor skill learning and retention.